Kaiser Daily HIV/AIDS Report Rounds Up News From the Sixth International Conference on HIV/AIDS in the Asia/Pacific Region

The Sixth International Congress on AIDS in Asia and the Pacific, which addressed regional issues such as local AIDS epidemics, poverty and access to treatment, as well as broader topics such as AIDS vaccines, ended today in Melbourne, Australia. Before the opening of the conference on Friday evening, Werasit Sittitrai, associate director of UNAIDS' Asia, Pacific and Middle East Division, said that the summit "comes at a time when some countries have become complacent about the virus" and feel that it will not infect their inhabitants. A day-by-day chronology of the media's coverage of the conference appears below.

Saturday
Saturday's discussion included a speech on the potential cost of fighting HIV/AIDS in East Asia, with health officials stating that anti-AIDS initiatives could cost nearly $10 billion per year for the next decade. International AIDS Society President Stefano Vella said that AIDS prevention, treatment and support efforts in the region will cost between $7 billion and $9 billion per year for "at least 10 years." Vella added that improving HIV/AIDS efforts in eastern Asia will be "difficult" because of the numerous barriers to care, including the lack of health infrastructure, the presence of "other health emergencies," the high cost of AIDS drugs and the "complexity" of current drug regimens, which are often "not used correctly by people in Asia." Vella said that the cost of fighting HIV/AIDS in the region should be shouldered by "wealthy countries," which should work to improve access to health care. In addition, he said, efforts should be made to create health facilities that could treat HIV and other "common" Asian diseases, such as tuberculosis and malaria (Tinkler, Associated Press, 10/6).

Sunday
The following events took place on Sunday:

• Margaret Johnston, associate director of AIDS vaccines at NIH, said that an AIDS vaccine could be available within 10 years, although it may not be totally effective. Johnston said that a concrete date for vaccine production is far from certain, stating, "The very soonest we can have a vaccine is maybe four to five years from now and that's wildly optimistic -- more likely ... (it) will take seven to nine or 10 years." She said that the "most advanced" vaccine candidate is VaxGen's AIDSVAX vaccine, which is made from the gp120 protein that forms the outer surface of HIV and "stimulates antibodies to neutralize or stop the virus from spreading." This vaccine candidate is currently being tested in Thailand, North America and the Netherlands, and could move to a larger clinical trial if results prove "promising." Johnston said that a purchase fund of $500 million to $1 billion established by the World Bank and other companies might "encourage" pharmaceutical firms to invest in AIDS vaccine production and "ensure [the vaccine] was available to those countries most in need of it" (Tinkler, AP/San Francisco Chronicle, 10/7).
• Women who live in rural or island communities in Southern Asia and the Pacific are "especially vulnerable" to HIV infection because of the cultural, economic and social barriers that they face, a group of wives of the region's political leaders said at a Sunday news conference. The first ladies of Malaysia, Fiji, Mongolia and Kyrgyzstan said that the topic of HIV/AIDS among rural and island women is "critical" because the women's "low social and economic standing" leaves them at risk of contracting the virus. Malaysian first lady Siti Hasmah Binti Haji Mohd Ali said that such women often are unable to "negotiate for safe sex with their partners," are often largely uneducated, are sometimes "forced" into sex work to earn money and are subject to cultural taboos that discourage discussion of sex. She added that when the women find out they are infected they often cannot seek treatment due to "the stigma and discrimination associated with the disease" (Thieberger, Reuters, 10/7). The first ladies, along with representatives of the first ladies of Tonga, India and Vietnam, presented yesterday a statement of commitment to fighting HIV/AIDS to delegates attending the Asia Pacific Ministerial Meeting (Pollard, Sydney Morning Herald, 10/8).
• Buddhist Leadership Initiative leader Laurie Maund and a group of monks from Thailand and Laos led a Buddhist chant at the conference on Sunday to demonstrate Buddhist clerics' commitment to fighting HIV/AIDS. Maund said, "The AIDS crisis fits in with Buddhist teaching perfectly because ... it is about suffering. If we look at AIDS in terms of suffering then the monks will respond." Through a UNICEF initiative, more than 2,000 Buddhist monks and nuns have been trained in how to help care for HIV-positive individuals and educate communities about HIV. The monks work in Thailand, Cambodia, Laos, Myanmar, Vietnam, Bhutan, Mongolia and southern China (Associated Press, 10/7).

Monday
Monday's session included a discussion of the link between poverty and the spread of HIV in the Asia/Pacific region. Indrana Gupta, associate professor at the Institute of Economic Growth in India, said that alleviating poverty is key to stemming the spread of HIV/AIDS in the area. Gupta cited a recent World Bank report stating that in East Asia, 15% of the population lives below the poverty line. She said, "We have huge numbers (of people) who are desperately poor and are living in conditions that are conducive to a high spread of the (HIV) epidemic." The virus is currently spread primarily through intravenous drug use and sexual contact, two methods that "are highly related to underdevelopment poverty," Gupta said. She added that governments, economists and health organizations must include poverty relief along with other HIV/AIDS prevention programs (Tinkler, Associated Press, 10/8). Australian Council of Trade Unions President Sharan Burrow added that sex workers need to receive adequate health care to help prevent the spread of HIV (Agence France-Presse, 10/8).

Tuesday
Tuesday's session included speeches on the issue of AIDS orphans, a topic that is "often forgotten" in discussions of HIV/AIDS, according to a children's organization. Between three million and four million children in South and Southeast Asia have lost one or both parents to HIV/AIDS, and that number could "rise sharply" as more children born to HIV-positive mothers receive antiretroviral treatment to prevent vertical transmission, according to a new report released Tuesday by the Save the Children Fund. The report stated that many AIDS orphans in the region are often placed in institutions where care is "inadequate." The children also face "sexual exploitation, trafficking and homelessness" as a result of the discrimination they experience, rendering them vulnerable to HIV infection, the report said. The report suggested an increased focus on providing community-based care for AIDS orphans, with institutional care "provided as a last resort" (Reuters, 10/9).

Wednesday
AIDS groups called for loosened patent laws and "an end to religious and traditional barriers" that stigmatize HIV-positive individuals in today's sessions. Vella said that pharmaceutical companies must "relinquish patent rights to allow cheaper generic drugs to be sold" because the high cost of AIDS drugs represents "a major factor for the lack of access to therapy in developing countries." Vella added that wealthier nations should shoulder the cost of drug treatment for residents of developing nations. Congress Chair Rob Moodie stated that more must be done by clerics and governments to eliminate the stigma of HIV. "Many governments, religious leaders, educational institutions and even NGOs refuse to acknowledge the existence of groups particularly vulnerable to HIV infection, such as drug users, sex workers, men who have sex with men, ethnic minorities [and] transgendered people," he said (Agence France-Presse, 10/10).

Ministers Hold Concurrent Meeting on AIDS
Today also marked the final day of the Asia Pacific Ministerial Meeting on HIV/AIDS, which was held in Melbourne in tandem with the international AIDS conference. Thirty-three ministers from Asian/Pacific nations agreed at the meeting to "encourage the further development of national action plans on AIDS prevention, care and treatment" (Tinkler, Associated Press, 10/10). Australian Foreign Minister Alexander Downer stated that governments must "closely heed" the HIV/AIDS epidemic in the Asia/Pacific region because it could damage the social and economic structure of the area. The virus puts "at risk the gains made from years of development in Asia," including advances in economic growth, health improvement and gains in living standards (Associated Press, 10/9). Last year, Australia announced it would allocate $100 million toward a global initiative to fight HIV/AIDS; Downer announced at the meeting that $25 million of this fund would be spent on three Asia/Pacific anti-AIDS projects. The initiatives will target intravenous drug users in Asia and prevention programs in Indonesia and will help Pacific island nations implement national AIDS strategies (Reuters, 10/10). Downer added that Australia would, "if asked," help other Asia/Pacific governments draft legislation to "facilitate cost-effective access to essential HIV/AIDS drugs." However, he said that Australia is "determin[ed]" to adhere to international trade laws regarding the patents on AIDS drugs (Associated Press, 10/10). The ministers at the meeting said they would reconvene in two years to check their progress on the efforts (Reuters, 10/10).